Skip to main content
SpringerLink
Log in

Azoospermia

  • Chapter
  • First Online:
Clinical Management of Male Infertility

Abstract

Azoospermia is defined as the complete absence of sperm in the ejaculate even after centrifugation. With a prevalence of 1 % among the general male population and 10–15 % among infertile men, it can be classified in two large groups: obstructive and non-obstructive azoospermia (OA and NOA). The first is caused by an obstruction in the seminal tract (epididymis, vas, ejaculatory ducts), and the latter is due to impaired sperm production by the testis because of congenital maldevelopment and genetic, hormonal and acquired conditions. Diagnostic workup of azoospermia includes personal and familiar history, clinical evaluation, hormonal and semen biochemical assessment, scrotal and distal seminal tract transrectal ultrasounds and invasive investigations such as testicular fine needle aspiration, open biopsy and, in selected cases, vasography. OA can be treated by surgical recanalization of the seminal tract or sperm retrieval for ART. NOA treatment is represented by sperm retrieval for ART. Only the rare cases of hypogonadotropic hypogonadism might benefit from a medical treatment. MicroTESE has recently been proposed as an optimal method for sperm retrieval in NOA, and we describe a novel stepwise approach of this technique to reduce invasivity.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Colpi GM, Franco G, Greco E, Ortensi A, Palermo R (1998) Linee Guida Società Italiana di Andrologia su: l’azoospermia. Parte Prima: la Diagnosi. Giornale italiano di andrologia 5/1:2–13

    Google Scholar 

  2. Thonneau P, Marchand S, Tallec A et al (1991) Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988–1989). Hum Reprod 6:811–816

    PubMed  CAS  Google Scholar 

  3. Jarow JP, Espeland MA, Lipshultz LI (1989) Evaluation of the azoospermic patient. J Urol 142:62–65

    PubMed  CAS  Google Scholar 

  4. American Society for Reproductive Medicine (2008) The management of infertility due to obstructive azoospermia. Fertil Steril 90:S121–S124

    Google Scholar 

  5. Reijo R, Lee TY, Salo P et al (1995) Diverse spermatogenic defects in humans caused by overlapping, de novo Y deletions encompassing a novel RNA-binding protein gene. Nat Genet 10:383–393

    Article  PubMed  CAS  Google Scholar 

  6. Poongothai J, Gopenath TS, Manonayaki S (2009) Genetics of human male infertility. Singapore Med J 50(4):336

    PubMed  CAS  Google Scholar 

  7. Kim ED, Leibman BB, Grinblat DM, Lipshultz LI (1999) Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure. J Urol 162:737–740

    Article  PubMed  CAS  Google Scholar 

  8. Silber SJ, Grotjan HE (2004) Microscopic vasectomy reversal 30 years later: a summary of 4010 cases by the same surgeon. J Androl 25(6):845–859

    PubMed  Google Scholar 

  9. Monoski MA, Schiff J, Li PS, Chan PT, Goldstein M (2007) Innovative single-armed suture technique for microsurgical vasoepididymostomy. Urology 69(4):800–804

    Article  PubMed  Google Scholar 

  10. Franco G, Gandini L, Ciccariello M, Martini M, Fabbri A, Laurenti C (1995) Trans perineal distal seminal tract sperm aspiration: an alternative treatment to transurethral resection of the ejaculatory ducts? J Urol 153(Suppl):261a

    Google Scholar 

  11. Franco G, Leonardo C, Dente D, Iori F, De Cillis A, Cavaliere A, De Nunzio C, Laurenti C (2009) Treatment of ejaculatory duct obstruction: a new algorithm. J Urol 181(4):735a

    Article  Google Scholar 

  12. Foresta C, Ferlin A, Franco G, Gandini L, Garolla A, Krausz C, Lenzi A, Sinisi AA (2005) Percorso andrologico: Terapia delle azoospermie ostruttive. In: Foresta C, Lanzone A, Ferlin A (eds) Consensus: iter terapeutico della coppia infertile. Cleup. Padova, pp 258–263

    Google Scholar 

  13. Lee R, Li PS, Goldstein M, Tanrikut C, Schattman G, Schlegel PN (2008) A decision analysis of treatments for obstructive azoospermia. Hum Reprod 23(9):2043–2049

    Article  PubMed  CAS  Google Scholar 

  14. Palermo G, Joris H, Devroey P, Van Steirteghem AC (1992) Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet 340:17–18

    Article  PubMed  CAS  Google Scholar 

  15. Silber SJ, Ord T, Borrero C, Balmaceda J, Asch R (1987) New treatment for infertility due to congenital absence of the vas deferens. Lancet 2:850–851

    Article  PubMed  CAS  Google Scholar 

  16. Silber SJ, Nagy ZP, Liu J, Godoy H, Devroey P, Van Steirteghem AC (1994) Conventional in-vitro fertilization versus intracytoplasmic sperm injection for patients requiring microsurgical sperm aspiration. Hum Reprod 9:1705–1709

    PubMed  CAS  Google Scholar 

  17. Belker A (1994) The sperm microaspiration retrieval techniques study group. Results in the United States with sperm microaspiration retrieval techniques and assisted reproductive technologies. J Urol 151:1255–1259

    Google Scholar 

  18. American Society for Reproductive Medicine (2008) Sperm retrieval for obstructive azoospermia. Fertil Steril 90:S213–S218

    Google Scholar 

  19. Hovatta O, Moilanen J, Von Smitten K, Reima I (1995) Testicular needle biopsy, open biopsy, epididymal aspiration and intracytoplasmic sperm injection in obstructive azoospermia. Hum Reprod 10:2595–2599

    PubMed  CAS  Google Scholar 

  20. Craft I, Tsirigotis M, Bennet V et al (1995) Percutaneous epididymal sperm aspiration and intracytoplasmic sperm injection in the management of infertility due to obstructive azoospermia. Fertil Steril 63(5):1038–1042

    PubMed  CAS  Google Scholar 

  21. Belker AM, Louisville KY, Sherins RJ et al (1996) High fertilization and pregnancy rates obtained by nonsurgical percutaneous needle aspiration of testicular sperm. J Urol 155(Suppl):364A

    Google Scholar 

  22. Franco G, Di Marco M, Martini M, Di Crosta G, Laurenti C (1996) A new minimally invasive approach of MESA. Minim Invasive Ther Allied Technol 5(Suppl 1):66

    Google Scholar 

  23. Franco G, Rocchegiani A, Di Marco M, Martini M, Presta L, Laurenti C (1996) Un nuovo approccio mini-invasivo di MESA. In: Menchini Fabris F, Rossi P (eds) Andrologia '96. Monduzzi, Bologna, pp 357–361

    Google Scholar 

  24. Nudell DL, Conaghan J, Pedersen RA, Givens GR, Schriock ED, Turek PJ (1998) The Mini-Mesa for sperm retrieval: a study of urological outcomes. Hum Reprod 13:1260–1265

    Article  PubMed  CAS  Google Scholar 

  25. Oates RD, Dubay A, Harris D et al (1995) Efficacy of Intracytoplasmic Sperm Injection (ICSI) using cryopreserved epididymal sperm: preliminary results. J Urol 153(Suppl):497A

    Google Scholar 

  26. Hauser R, Yoghev L, Paz C et al (2006) Comparison of efficacy of two techniques for testicular sperm retrieval in nonobstructive azoospermia: multifocal testicular sperm extraction versus multifocal testicular sperm aspiration. J Androl 27(1):28–33

    Article  PubMed  Google Scholar 

  27. Devroey P, Liu J, Nagy Z et al (1995) Pregnancies after testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI) in nonobstructive azoospermia. Hum Reprod 10:1457–1460

    Article  PubMed  CAS  Google Scholar 

  28. Schlegel PN (1999) Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod 14:131–135

    Article  PubMed  CAS  Google Scholar 

  29. Tsujimura A (2007) Microdissection testicular sperm extraction: prediction, outcome, and complications. Int J Urol 14:883–889

    Article  PubMed  Google Scholar 

  30. Talas H, Yaman O, Aydos K (2007) Outcome of repeated micro-surgical testicular sperm extraction in patients with non-obstructive azoospermia. Asian J Androl 9(5):668–673

    Article  PubMed  Google Scholar 

  31. Ravizzini P, Carizza C, Abdelmassih V, Abdelmassih S, Azevedo M, Abdelmassih R (2008) Microdissection testicular sperm extraction and IVF-ICSI outcome in nonobstructive azoospermia. Andrologia 40(4):219–226

    Article  PubMed  CAS  Google Scholar 

  32. Franco G, Zavaglia D, Cavaliere A, Iacobelli M, Leonardo C, De Cillis A, Petrucci F, Greco E (2009) A novel stepwise approach of microtese in nonobstructive azoospermia. J Urol 181(4):731A

    Article  Google Scholar 

  33. Takada S, Tsujimura A, Ueda T, Matsuoka Y, Takao T, Miyagawa Y, Koga M, Takeyama M, Okamoto Y, Matsumiya K, Fujioka H, Nonomura N, Okuyama A (2008) Androgen decline in patients with nonobstructive azoospermia after microdissection testicular sperm extraction. Urology 72(1):114–118

    Article  PubMed  Google Scholar 

  34. Ramasamy R, Yagan N, Schlegel PN (2005) Structural and functional changes to the testis after conventional versus microdissection testicular sperm extraction. Urology 65(6):1190–1194

    Article  PubMed  Google Scholar 

  35. Verheyen G, Vernaeve V, Van Landuyt L et al (2004) Should diagnostic sperm retrieval followed by cryopreservation for later ICSI be the procedure of choice for all patients with non-obstructive azoospermia? Hum Reprod 19(12):2822–2830

    Article  PubMed  CAS  Google Scholar 

  36. Ramasamy R, Padilla WO, Osterberg EC, Srivastava A, Reifsnyder JE, Niederberger C, Schlegel PN (2013) A comparison of models for predicting sperm retrieval before microdissection testicular sperm extraction in men with nonobstructive azoospermia. J Urol 189(2):638–642

    Article  PubMed  Google Scholar 

  37. Pening D, Delbaere A, Devreker F (2014) Predictive factors of sperm recovery after testicular biopsy among non-obstructive azoospermic patients. Obstet Gynecol 123(Suppl 1):189S–190S

    Article  PubMed  Google Scholar 

  38. Marconi M, Keudel A, Diemer T, Bergmann M, Steger K, Schuppe HC, Weidner W (2012) Combined trifocal and microsurgical testicular sperm extraction is the best technique for testicular sperm retrieval in “low-chance” nonobstructive azoospermia. Eur Urol 62(4):713–719

    Article  PubMed  Google Scholar 

  39. Kim ED (2014) Using contemporary microdissection testicular sperm extraction techniques, older men with nonobstructive azoospermia should not be deterred from becoming fathers. Fertil Steril 101(3):635

    Article  PubMed  Google Scholar 

  40. Deruyver Y, Vanderschueren D, Van der Aa F (2014) Outcome of microdissection TESE compared with conventional TESE in non-obstructive azoospermia: a systematic review. Andrology 2(1):20–24

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gynecological-Obstetrical and Urological Sciences, Sapienza, University of Rome, Viale del Policlinico, Rome, 00163, Italy

    Giorgio Franco, Leonardo Misuraca & Gabriele Tuderti

Authors
  1. Giorgio Franco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leonardo Misuraca
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabriele Tuderti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giorgio Franco .

Editor information

Editors and Affiliations

  1. Andrological Unit, Gynepro Medical Team, Bologna, Italy

    Giorgio Cavallini

  2. Andrological and Reproductive Medicine Unit, Centro Demetra, Firenze, Italy

    Giovanni Beretta

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Franco, G., Misuraca, L., Tuderti, G. (2015). Azoospermia. In: Cavallini, G., Beretta, G. (eds) Clinical Management of Male Infertility. Springer, Cham. https://doi.org/10.1007/978-3-319-08503-6_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-08503-6_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-08502-9

  • Online ISBN: 978-3-319-08503-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation